Date of Award


Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Leah M. Ferrucci

Second Advisor

Brenda Cartmel


Background – Smoking has been identified as a risk factor for many cancers. While many studies have investigated the association between smoking and basal cell carcinoma (BCC), the results have been inconsistent, and no study has evaluated this association among a young population.

Methods – Early-onset BCC cases (n=374) and controls with minor benign skin conditions (n=384) under age 40 were identified through Yale Dermatopathology. Participants over 18 years old were asked whether they ever smoked (defined as ever smoked at least 100 cigarettes) during an in-person interview. Those who responded affirmatively were then asked about their smoking history. We calculated odds ratios (OR) and 95% confidence intervals (CI) for the association between smoking and early-onset BCC using unconditional multivariate logistic regression.

Results – Current smokers had significantly lower odds of having early-onset BCC compared to non-smokers (OR=0.43, 95% CI=0.24-0.77). There was no evidence for a clear dose-response effect by pack-years, but there was a statistically significant inverse association for younger age at smoking initiation (OR for below median vs non-smokers=0.62, 95% CI=0.40-0.96). We did not find evidence that alcohol consumption, site of skin biopsy or sex were effect modifiers of the association between smoking and BCC.

Conclusions – Overall, we observed an inverse association between smoking status and early-onset BCC. Replication in other populations is important to further clarify this association.

Open Access

This Article is Open Access

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